Relationship of Coxsackievirus to Cardiac Autoimmunity

Abstract

For many years, a relationship between viral infection and the development of autoimmunity has been suspected in diseases such as diabetes mellitus,1–3 multiple sclerosis,45 idiopathic thrombocytopenia purpura,6 chronic active hepatitis,7 postmeasles encephalitis,8,9 and myocarditis.10,12 During the past decade, significant strides have been made in developing an understanding of this intricate and involved relationship. Some of the most studied experimental models are encephalomyocarditic virus-induced and coxsackievirus B4 (CVB4)-induced diabetes mellitus in mice, which have been investigated by Notkins and Yoon and colleagues.1,13–15 Their studies have shown that both the genetics of the host and the infectious agent determine the host’s susceptibility to viral infection, the virus-induced pathology, and the development of autoimmune disease. These investigators have also attempted to clarify the relationship of the virus with organ-specific autoimmunity by hybridizing antibody-forming cells of infected mice. Multiple organ-reactive monoclonal antibodies were produced in the wake of a reovirus infection.16–17 These studies also demonstrated that there are sometimes shared epitopes between the virus and host tissues.